What do you want to be called when you are old? Dear? Love? Babe? Surely you wouldn't want to be "a bedblocker"? Or maybe you already are old. Well done for reading and everything, you silver-surfer you! If you don't want to be patronised you had better plan ahead. I want to be called Suzanne, as that's my actual name, and to lie in a white clinic like something in a Fassbinder film, with the Rolls-Royce of opiates going into one arm while loved ones bring me the finest wines knows to humanity …

That's the fantasy, but I have been to hospitals recently where I have had to have an argument to get an elderly post-operative patient a bowl of cornflakes. That was not very dignified. Much of what goes on in hospitals and care homes isn't, which is why an organisation called Dignity in Care has told those who work with the elderly to speak to them properly. As human beings. Yelling "How is she doing today?" over someone's head as if they were not there is simply rude.

People are rude, though. Ages ago I went to a cafe with a boy named Joe. Joe was using a wheelchair so the manager came rushing over to me and said: "We don't serve wheelchairs." "That's fine," said Joe. "My wheelchair is not hungry." We know so much better now, I thought.

But old people do lie neglected and unspoken to in some wards, so that now a hospital visit is a form of advocacy. Those without visiting relatives too often have trays of food dumped in front of them that they simply cannot manage.

We can argue over why standards of care have slipped, but not whether they have. If I am sentimental over the NHS, it is perhaps because it has saved my life and that of two of my children (one had a bike accident, the other meningitis), thus I have seen care at its very best: the gentle hair-washing of a child with a fractured skull, lip-balm applied to a toddler on life support. I have seen the same in a hospice where care was given to those no longer conscious but who are spoken to as if they were. "Hearing is the last thing to go. We don't know do we?" a nurse told me. Watching such kindness is indeed awe-inspiring. Care, one immediately intuits, is communication.

Who doesn't know this? Why are we in a position where doctors and care workers have to be told to treat the elderly with respect? Or that dignity means letting people go to the loo in private?

The Dignity In Care report says that some cleaners talk more to patients than medics do, and that perhaps academic qualifications are less important than compassion. Fine words indeed: communication; caring; compassion. We don't pay much for them.

Those who look after older people and have no NVQs start at £5.90 an hour. Caring is mostly done by low-paid women. When things go wrong we are scandalised, but we must recognise how difficult some of this work is. It is hard to look after someone with dementia who is being aggressive. Still, the controversial word in the health and social care bill is not compassion, is it? That's unquantifiable. It is competition that will magically raise standards.

For many, the first real-life encounter they ever have with private care will be an old people's home. Then private care may not look luxurious, but tatty and grubby. Nonetheless, choice and private provision are the main components of this bill. So unpopular are many of its aims with key professionals, it needs a very effective communicator to sell it. Instead there is Andrew Lansley. This grey man of middle management embodies exactly what he seeks to do away with: bureaucracy. Lansley looks so shifty that I wouldn't buy a secondhand kidney from him, though I imagine some deal is being done there already.

Even those who once supported him are now backing away, for all the talk of putting healthcare into the hands of local GPs turns into the walk of centralising it (another layer of management), and in such a way that puts the private sector at its core. More simply, every promise that the Tories made about safeguarding the NHS is being broken. Yes, Labour did introduce a degree of competition but this level of privatisation is shocking.

I heartily recommend a Teach Yourself Lansley guide by John Lister (@JohnRLister on Twitter). The words the health secretary uses may sound like normal English but they aren't. "No top-down reorganisation" means "the biggest reorganisation since 1948". "Monitoring" means the likes of "[US consultancy] McKinsey & Co reshaping the NHS as a network of businesses" and Lansley's "listening exercise" means "ostentatiously ignoring opposing views".

The future, though, is already here. We are no longer talking about patient care but "customer contact". Dignity in Care says older people are already being failed and that respect is as important as medical success rates or financial targets. Are they in another world? For this bill is all about "patient choice", which sounds wonderful until you realise that for most people it simply means choosing not what they need but what is the cheapest. Compassion is not so much out to tender as out of the window. And those who love and respect the NHS feel nauseous as cherished values are surgically removed one by one.